Essential products
Novation lists the following as essential equipment required to effectively serve the bariatric patient: Beds, lift systems, scales, wheelchairs, bedside commodes or floor-mounted toilets, stretchers, air transfer devices, and waiting room furniture. Beyond these essential items, Novation offers a complete portfolio of bariatric products. Suppliers such as TSK Products, Medline Industries, SizeWise Rentals, Cardinal Health and Bariatrics Unlimited can also provide a one-stop resource for many of these essential items.

Liko Viking XL

Lift systems
According to the U.S. Department of Labor, Bureau of Labor Statistics, 2000, healthcare workers sustain 4.5 times more overexertion injuries than any other type of worker. Six of the top 10 professions at greatest risk for back injury are nurse’s aids, licensed practical nurses, registered nurses, health aides, radiology technicians and physical therapists.

According to the Novation survey, 28 percent of respondents saw an increase in workforce injuries in 2004 related to caring for obese patients, forcing hospitals to implement special training sessions to educate their staff on the safest way to lift and transfer obese patients. When moving a bariatric patient, the risks for injury obviously are much greater, and therefore require special equipment or the use of "lift teams". Moving patients with safety and dignity is a priority when it comes to bariatric product selection.

Janet White, president Bariatrics Unlimited, said, "The financial consequence of not investing in bariatric patient handling equipment are huge, since more than 80% of back injuries among healthcare workers are attributed to patient handling. According to the U.S. Bureau of Labor Statistics, nursing personnel lose an average of 750,000 work days per year as a result of back injury. Each incident has costs ranging from $5,000 to $100,000; average direct costs are $20,000, and indirect costs are significantly more."

"We have seen a three-fold increase in the demand for bariatric products over the past year," said Randy Smith, T.H.E. Medical, a supplier of patient handling systems. "The biggest concern is how are we going to move the patient that is going to be safe for the staff, yet comfortable and dignifying for the patient?"

A number of suppliers provide educational programs centered around safe lifting procedures and back injury prevention. Wise notes that 84% of Novation’s survey respondents said that they offer training regarding special procedures for the proper treatment of obese patients, the most common of which are patient lifting and transfer, body mechanics and the use of lifting devices.

Airpal photo courtesy Hill-Rom

ARJO Inc.’s injury prevention programs include a Back Injury Prevention Program (BIPP) that offers up to a 60% guaranteed reduction in transfer related incidents and an AHA-endorsed Diligent program that offers a long-term, comprehensive, hands-on approach to injury prevention. ARJO has instituted over 2,000 Back Injury Prevention programs and 200 3-year partnerships with Diligent. "We are very concerned with educating our customers on transferring and bathing obese patients. We recognize the unique needs this creates and have modified our ‘Guidebook for Architects’ with a chapter on this very issue," notes Amy McCaw, Marketing Coordinator, ARJO. ARJO’s facility assessment analyzes the existing layout and patient population categorized by mobility, then proposes a list of transferring products ranging from ceiling lifts and floor lifts (for passive individuals) to active lifters to assist standing (for limited assist).

ARJO carries a 705-lb. floor lift; 600 and 1,000 lbs. ceiling lift system and overhead gantry. The company’s ceiling lift systems feature automatic return after 15 minutes of non-use to the charging station. The company’s Dynamic Positioning System (DPS) four point hangar bar and sling allows the patient to be completely rotated from a semi reclined position to a seated position without having to push down on the patient’s legs or tug on the sling handles.

Liko Inc. offers ceiling mounted and freestanding overhead lift systems and mobile floor lifts, ambulatory bariatric lifts, gait training accessories, pool lifts for rehab, overhead systems for bariatric operating rooms and hospital diagnostic facilities, as well as slings. Its UltraTwin FreeSpan features X-Y positioning capability and a lifting capacity of 1,012 lbs. The freestanding unit is mounted on a multiple caster chassis and can be easily moved from room to room. With dual-motor configuration, Liko’s UltraTwin overhead system gives bariatric patients the ability to easily tilt themselves forward or backward while suspended over a bed, wheelchair or commode. This helps to improve comfort, instill a sense of self-control and improve breathing. Liko’s Viking XL mobile floor lifts weigh just 95 lbs. but have a lifting capacity of 660 lbs. and can be used for lifting from the floor, transferring patients between bed and wheelchair, to and from toilet or bathtub, weighing patients in the lift, and lifting patients in a horizontal stretcher. Dan Gilmore, director marketing communications, Liko, notes that the company’s ceiling mounted lift systems are gaining popularity because of mounting flexibility in both new and existing structures. They’re available in single track versions using both straight and curved rail sections, plus gantry-style X-Y versions that can serve multi-bed rooms.

Hill-Rom lift

Liko’s educational resources department offers a number of safe patient handling alternatives designed to help individual facilities reduce caregiver injuries with minimum reliance on outside personnel.

The TITAN high capacity lift system from T.H.E. Medical is a mobile patient lift designed for bariatric patients up to 1,000 lbs. It has a wide hangar bar for added comfort, and will go to the floor should someone fall.

Smith notes that a number of facilities are looking at overhead ceiling lifts. "Bariatric ceiling lifts with full room coverage are the trend of the future," he said. "This allows a room to be covered from wall to wall without taking up floor space." T.H.E. Medical has designed a new line of Pinnacle ceiling lifts which has capacities of 400, 600, 800 and 1,000 lbs.

Hill-Rom’s Liftem portable lift can raise patients up to 700 lbs. from the floor, and can be operated from multiple positions around the bed. Hill-Rom offers a Detailed Ergonomics Evaluation Process (DEEP), Ergonomics Program Audit, Planning and Policy Development, and Staff Training and Education.

Whatever lift systems are implemented throughout the facility, continuous education on proper use is essential. "Education of staff is critical," said White of Bariatrics Unlimited. "Many facilities just purchase the equipment and then it sits in the closet. The hospital must develop and implement ‘no-lift’ strategies throughout the facility to ensure employees use proper technique and are consistently trained in use of equipment."

ARJO MaxiSlide

Transfer devices
Novation recently added air transfer devices to its list of "essential" bariatric products. These devices, such as the Airpal lateral transfer system, are used to transfer patients from bed to stretcher to other areas of the hospital. A launderable nylon transfer pad is placed under a patient and then inflated via a portable air supply. The air "lifts" the patient and allows two staff members to safely perform a task which previously required four to eight. The Airpal offers patient comfort while maintaining skin integrity. Patients may remain on the radio lucent transfer pad for all ancillary procedures, including radiology, CT scan, radiation therapy, heart catheterization, physical therapy, labor and delivery, OR and ED.

In addition, extra wide sliding sheets such as those offered by ARJO can be used for repositioning patients.

TransMotion Medical

Transport equipment
Transport chairs that transform easily from chair to stretcher and multiple positions in between may prove to be a worthwhile investment for any facility and will help to eliminate many transfers all together.

Stretchair offers such a specialized wheelchair in varying seat widths from 19 ½", to 28", to 32" and weight capacity ranges from 300 to 1000 lbs. "A Stretchair in a bariatric suite or hospital room lessens dependence upon other auxiliary equipment such as bedside chairs, walkers and canes," notes Emil A. Scordato, CEO, Stretchair.

Camtec’s CareChair is available with weight capacities of 400, 650, and 850 lbs. and seat widths from 18" to 31". The chair allows you to put the patient into the supine, or stretcher position for a lateral transfer, and then set the patient upright, eliminating chair to bed transfers or the need for hoists and lifts to transfer a patient from a bed to a chair. Split legs are adjustable in both elevation and length, and are strong enough for the patient to stand upright on the foot plates and step off the chair. An optional commode seat is available.

TransMotion Medical Inc. offers two specialty treatment and transport chairs, a Multi-Purpose Treatment & Transport Chair and its Surgi-Chair, both with a 500 lb. weight limit. Both models are battery/ motorized powered for infinite positioning from a full chair to a fully reclined stretcher. Features include a low seat height for safer patient egress along with a wide and longer patient cushion surface. The Multi-Purpose Treatment & Transport Chair provides a fully radiolucent backrest that enables x-ray or fluoroscopic procedures. "The overall concept of the TransMotion Medical Line of Specialty multi-purpose stretcher chairs is to reduce patient transfer by permitting multiple patient treatments," notes Raymond A. Failor, president TransMotion Medical.

May Chair Corporation manufactures the Dyna-Po (Dynamic Positioning Chameleon) in several models that offer infinite tilt in space.

Hill-Rom provides the Barton 1-660 Transfer/chair system that also converts from a flat position to an upright mobile chair.

Clinical and recliner chairs
Winco Inc.’s #900 Bariatric Chair is a fully upholstered mobile bariatric chair with removable side arms and back, a

Winco 900 bariatric chair

 fold-down side tray a weight capacity of 1,000 lbs. and seat width of 31". Derek Holloway, national sales manager, Winco explains that the company’s bariatric products were designed for a non-institutional/ non-invasive presentation in hopes of alleviating the stigma of traditional bariatric products.

Winco also provides a fully upholstered bariatric blood drawing chair with adjustable armrest, padded seat and back, 24.5" seat width, and a 450 lb. weight capacity. Winco’s Clinical Chair w/ Drop Arms is an extra large reclining clinical chair with left/right drop arm features for ease in transfers and cleaning. Utilized in post-op surgery, dialysis, oncology and patient care, the chair has a 25" seat width and 450 lb. weight capacity.

UMF (United Medical Fabricators) manufactures an extra-wide podiatry chair that lowers to 19" and will lift up to 600 lbs.

Rehab Seating Systems manufactures and distributes medical specialty seating with a focus on bariatrics and orthopedics that are easy to enter and exit and support weights up to 1,000 lbs. The Ascender MP was added to provide a seat with ergonomic features to assist with mobility and sitting problems, but with an eye towards aesthetics and lower cost compared to the company’s high end clinical chairs. A variety of models and features make the chairs suitable for post-op care, patient room side chairs, waiting room chairs, and for transportation. High, firm seating is used to facilitate the sit to stand maneuver. In addition, the Ascender line of chairs has a retractable footrest and extended armrests with handgrips that assist in this maneuver.

May Chair Dyna-Po

"One of the more overlooked clinical requirements of bariatric patients, particularly those with orthopedic problems, is the simple task of sitting and rising from a chair," said David Ballantyne, vice president, sales and marketing, Rehab Seating Systems. "Most chairs are too low to the ground, requiring the patient to apply a high degree of stress to hip, knee and ankle joints just to sit and rise. Typically healthcare workers must assist these patients resulting in lifting injuries that are nearly epidemic among nursing staffs."

Novation bariatric patient room

Beds
Bariatric beds today have a wide range of features that while a big investment can provide a multitude of benefits. Look for low air loss surfaces, beds that aid egress, include cardiac chair positions, optional built-in scale features and trapezes.

Hill-Rom offers a full range of bariatric beds including its full-featured TotalCare Bariatric; ExcelCare which accommodates up to 1,000 lbs.; Magnum, a versatile bed, chair and transporter for patients up to 800 lbs., and CareSelections economical options with low air-loss therapy surfaces for patients up to 1,000 lbs. The TotalCare Bariatric is designed to help patients achieve mobility sooner and reduce caregiver injuries. With FullChair positioning, a choice of side or foot egress, the beds are designed to help patients get on their feet with less caregiver assistance. Equipped with Hill-Rom’s Intellidrive powered transport, a single caregiver can easily transport a patient. ExcelCare includes an expandable frame and mattress with side air bolsters that expand at the touch of a button from 40 to 50 inches wide. Magnum’s optional Flexicair Eclipse Ultra low-airloss therapy surface helps reduce the risk of pressure ulcers, a common problem with bariatric patients.

Camtec Products offers bariatric bed frames with weight capacities from 600 to 1,000 lbs. in either fixed width versions of 48" or 54" wide by 80" length. Camtec’s expandable bed transforms from a 37" to a 54" width, allowing it to be rolled through openings as narrow as 40", and allowing it to be used for both bariatric and non-bariatric patients. With the push of a button, the Camtec bed can be moved into cardiac chair position, full supine and trendelenberg positions. Swing out padded side rails, when locked out at the 45° position, can withstand 250 lbs of down load and will aid in egress out of the bed. The bed’s actuators can be operated by hand crank in the event of power failure or other malfunction.

SizeWise Rentals has developed a fully electric bariatric low-bed with a height range of 7" to 30" and a weight capacity of 850 pounds.

ARJO’s 1,000-lb. bed features a foot egress (exit). The company also provides 1,000-lb. therapeutic mattress replacement systems.

Scales
Proper weighing of patients is another must for many reasons. "Proper documentation of weight can ensure correct dosage of medications and dietary requirements," said Fred Cox, vice president of sales, Detecto Scale Company. "Many employers now reward their employees for weight reduction which in turn lowers insurance claims," he adds.

Detecto offers four basic scale models in 600 or 800 lb. weights designed to assure safety during the weighing process, with features such as flip-up arm rests, hand rails, and large, stable platforms. Detecto has stand on scales as well as models that can weight patients in both standing and seated positions.

All new Detecto bariatric scales include RS-232 interface with keypad entry of Time/Date/Patient ID/Height. The scales provide multiple choices of documenting weight data for Medicare and other patient requirements. The weight data may be printed directly on labels to be applied manually to a medical chart. The serial port can be connected to a PC for EMR (electronic medical records) software needs. Wireless transmission from the scale is also available.

Health o Meter Professional has 700 and 800 lb. capacity scales in both handrail and wheelchair models. Health o Meter’s ProPlus line of scales stores patient information, including BMI readings, has programmable download features, customizable display for patient weights, swivel head, USB and RS232 connectivity, lockout of kg/lb. mode so errors cannot be made by touching an incorrect button, manual tare input, updatable firmware, modular load cells for replacement and system diagnostics. A reweigh button is good for patients with any affliction that causes extreme movement on the scale.

Commodes and toilets
Klein notes that TSK recently added a line of bariatric floor-mounted toilets due to customer demand. Most hospital toilets are wall-mounted, he explains, which are not designed to carry a lot of weight. "We found a company that manufacturers a floor-mounted toilet that’s designed to handle 2,000 lbs. and has a wide seat," he said.

Novation has also added floor-mounted toilets, as well as larger-sized toilets to its portfolio.

Medline Industries offers a complete line of bath and shower equipment with suction cups for safety, drainage holes and solid brass inserts.

Patient care items
Care products for the bariatric patient can include drapes and gowns, socks and slippers, bedpans, blood pressure cuffs and even patient identification bracelets.

Trimline Medical Products Corp. manufactures both reusable and disposable blood pressure bariatric cuffs for connection to all NIBP monitors. Omni-Kuff Reusable Cuffs are color-coded by size and feature an antimicrobial treatment. Kuff-Link Reusable Cuffs are a traditional 2-piece nylon cuff and vinyl bladder cuffing system, that offer economy and easy cleanability. Tempa-Kuff Disposable Cuffs are color-coded by size and feature a soft, comfortable fabric. All three cuffing systems are latex-free.

E-Z International BREEZ

"The largest cause of misdiagnosed hypertension is the use of an adult size cuff on a large adult patient, said Richard F. Jacobson, president Trimline. "This problem is compounded for patients who have large, but short arms. Since many doctors insist that blood pressure be taken on the brachial artery and not on a more distal artery, our extra long size cuffs facilitate more accurate blood pressure measurement on these patients."

Principle Business Enterprises Inc. (PBE) offers its Tranquility XL+ Bariatric Disposable Brief for individuals with waist sizes of 64" to 84". The breathable soft side panels stretch to accommodate larger waist sizes and provide a tailored comfortable fit with less bunching and bulk. The XL+ Bariatric Brief has a refastenable tape system, and inner leg cuffs for leak protection. The brief has a retention capacity in excess of one quart, while still protecting sensitive skin. Wetness Indicators indicate when it’s time to change the brief.

Exam/treatment tables
Welner Enabled is a company with a unique history and a unique product to serve both the bariatric and disabled patient market. Welner Enabled was founded in honor of Dr. Sandra Welner, who devoted her life to research that would improve care for the disabled, and who herself became disabled following an accident. Dr. Welner died in 2001, but her brother continues her tradition with a second generation exam table based on Sandra’s original design. The Welner Legacy table features a low height of 18.5" and can raise a 650-lb. patient up to 39". The company claims it is the only 650-lb. capacity exam table to meet the new, more stringent UL standards.

For information on tax credits that can be achieved by purchasing ADA-approved equipment, such as the Welner Legacy table, visit Welner’s web site www.welnerenabled.com.

UMF offers a full line of bariatric exam and treatment tables including fully powered exam tables that lower to a low access height of 19" and will lift a weight capacity of up to 600 lbs. The company’s bariatric 5005 treatment table is being used for wound treatment care.

SizeWise Rentals’ 1,000 lb. capacity tilt table allows caregivers to safely and securely begin the process of mobilization. Anderson notes that the x-ray capabilities (in a standing position) were requested by surgeons who wanted to check for post-surgical leaks.

Furniture
Bariatric lounge chairs should be a staple in any hospital, not only to accommodate obese patients, but also their visitors who may also be overweight. Many companies offer stylish options that can easily complement a facility’s existing décor.

Nemschoff bariatric seating

Nemschoff offers six styles of bariatric seating, all available with a 30" or 40" seat width and a weight limit of 1,000 pounds. Arm rests are designed to support ingress and egress. Plus, each of these styles is part of a larger product family, allowing a facility or designer to use the same design throughout a hospital.

"When we introduced our bariatric products over three years ago, we took great care to make them not only functional, but to also make the chairs look good with great design," said Amy Nemschoff Hellman, manager, marketing communications, Nemschoff. All of Nemschoff’s products, including its bariatric seating, comes with a Nemschoff Lifetime Warranty.

KI’s AGI Three Collection of bariatric seating includes both chair and loveseat options.

Bariatric labeling standards
When it comes to bariatric products, just because a product says it can hold 500 lbs. doesn’t mean it will function properly when in use. Bariatric equipment leaves no room for shoddy workmanship or inferior quality materials. Not only is it crucial that they hold their weight limit claims, they must function properly and be comfortable and safe for the patient and caregiver to use.

Stretchair performs a wide variety of tests on its chair models to assure a comfortable margin of safety for each chair type. Tests include positioning the chair in its various orientations with calibrated weight discs, checking for impact resistance and stress analyzing critical parts.

KI displays its bariatric testing results including functional and proof static load limits for individual components of its bariatric chairs on its web site at www.ki.com/bariatric/bariatric
_seating _test.asp.